Case Study help needed, please. re: Endocrine Disorders

hi, i've asked for help with a case study once before and was give excellant advice! in fact, i got an a on it. so, thank you! now i have another due. we're winding up the semester and i'd love to keep my 'b'

yes, there are still many questions unanswered. i've studied hard during my first 2 semesters and have made excellent grades, however, i still feel like i don't know anything. sometimes i can critically think very well, but often i feel like a deer-in-a-headlight. i am in the lvn program and have a hard time thinking that i will be ready to sit for my nclex and work as a nurse by may!!! is this a normal feeling at this stage or should it be clicking? i sat with my instructors last week one-on-one just to discuss this - they all gave me crazy looks. the seem to think that i have what it takes and that i'm just worried about nothing. but i am worried. i would think by the end of the 2nd semester i could fill out a case study with out shedding any tears? but, notsomuch.

case study:

yl makes an appointment to come to the clinic where you are employed. she has been complaining of chronic fatigue, increased thirst, constant hunger and freq urination. she denies any pain, burning or low-back pain on urination. she tells you that she has a lady partsl yeast infection that she has treated numerous times with otc medication. she admits to starting smoking since going back to work full time as a clerk in a loan company. she also complains of having difficult reading numbers and reports making frequent mistakes. she says "by the time i get home and make supper for my family, then put my child to bed, i am too tired to exercise" she reports her feet hurt; they often "burn or feel like there are pins in them" she reports that, after her delivery, she went back to her traditional eating pattern, which is high in cho

in reviewing yl chart, you notice she has not been seen since the delivery of her child 6 years ago. she has gained considerable wt, her current wt is 173 lbs. today, her bp is 152/97 and her plasma glucose is 291. her pcp orders the following labs: us hba1, fasting cmp, cbc, fasting lipid profile and gfr. the lab values are as follows: fasting glucose 184, hba1 10.4, ua+glucose, -ketones, cholesterol 256, triglycerides 346, ldl 155, hdl 32, ration 8.0 a subsequent fasting glucose is also elevated, and yl is diagnosed with type 2 diabetes mellitus.

after meeting with yl and discussing management therapies, the pcp decides to start multiple does injection insulin therapy and have the patient count cho. yl is scheduled for education classes and is to work with the diabetes team to get her blood glucose under control.

1. id 3 methods used to diagnose dm

fasting blood glucose

hb a1 (?)

????

2. id 3 functions of insulin

regulates glucose metabolism

stimulates lipogenesis

stimulates growth

3. insulin's main action is to lower blood glucose levesl. several hormones produced in the body inhibit the effects of insulin. id 3

4. yl was started on lispro and glargine insulin with cho counting. what is the most important point to make when teaching the pt about glargine

5. because yl has been on regular insulin in the past, you want to ensure she understands the difference between regular and lispro. what is the most significant difference between these two insulins

6. what is the peak time and duration for lispro insulin

peak: 1-2 hours

duration: 3-5 hours

7. yl wants to know why she can't take nph and regular insulin. she is more familiar with them and has taken them in the past. explain the advantages of glargine and lispro over nph and regular insulin

advantage of glargine: it provides patients a longer duration of insulin (24hours), therefore, decreases the risk for nocturnal hypoglycemia.

advantage of lispro:???

8. yl's culture prefers foods high in cho. what is cho counting and why would this method work well for yl

cho counting is a method for controlling the amount of cho you eat at meals and snacks. by counting carbohydrates in food, you can control the portion you have in every meal and the total you have for the day. it will help yl improve her blood glucose control (which will decrease risk for future complications) and help her to better interpret her blood glucose readings.

9. which of the symptoms that yl reported today led you to believe she has some form of neuropathy

c/o burning feet with the sensation of pins pricking in them

10. what findings in yl's history place her at increased risk for the development of other forms of neuropathy

11. what are some changes that yl can make to reduce the risk or slow the progression both macrovascular and microvascular disease

12. yl is enrolled in a smoking cessation class. what is it so important that she stop smoking

smoking raises blood sugar levels and decreases body's ability to use insulin, making it hard to control diabetes. [color=#474a51]other complications of smoking on diabetes include retinopathy (eye disease), heart disease, stroke, vascular disease, kidney disease, nerve damage, foot problems, and many others

so, i would appreciate any guidance on this. not even straight answers, just some nudging toward the right direction....

thank you

a student who wants to be a nurse really (really) bad :)